Masui. The Japanese journal of anesthesiology
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The number of epileptic patients scheduled to receive anesthesia and operation is not small. The management of anesthesia for epileptic patients requires caution and prudence. ⋯ Drug interactions of anticonvulsants and muscle relaxants or opioids and other drugs are also to be considered. Volatile anesthetics and intravenous anesthetics have both anticonvulsant and convulsive properties, although the convulsive properties of clinical doses of these anesthetics are permissible.
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The muscular dystrophies are inherited myogenic disorders characterized by progressive muscle wasting and weakness of variable distribution and severity. They can be subdivided into several groups, including congenital forms, in accordance with the distribution of predominant muscle weakness: Duchenne/Becker; limb-girdle; Fukuyama type congenital muscular dystrophy; Emery-Dreifus; facioscapulohumeral; oculopharyngeal; myotonic dystrophy, et al. ⋯ Depolarizing neuromuscular blocking drugs that cause rhabdomyolysis are contraindicated in these patients. Recommendations are proposed for the safe anesthetic management of these patients.
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Two principles should be kept in mind when performing preoperative evaluation of the elderly patient. First, we should suspect the disease processes commonly associated with aging. Second, we should assess the degree of functional reserve of specific, pertinent organ systems. ⋯ Especially, it is important to examine the cardiovascular and respiratory functions in the elderly patient. Further, this also includes assessment of consumed drugs, physiological function, cognitive function, competency, availability of social support, and sign of depression. Surgical risk and outcome in the elderly patient depend primarily on four factors: age, the patient's physiological status and coexisting disease, whether the surgery is elective or urgent, and the type of procedures.
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Malignant hyperthermia (MH) is a potentially fatal complication of general anesthesia following exposure to a depolarizing muscle relaxant and/or volatile anesthetics. MH is inherited as autosomal dominant and is thought to result from disordered Ca2+ regulation by the sarcoplasmic reticulum of the skeletal muscle. ⋯ It is difficult to diagnose by usual examinations preoperatively. Therefore, early detection, prompt treatment, discontinuation of triggering agents, and sufficient administration of dantrolene are needed.
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Difficult airway management (DAM) including cannot intubate and cannot ventilate (CICV), and difficult mask ventilation is a life threatening issue during anesthesia care. Although American Society of Anesthesiologists (ASA) has presented the guideline for this purpose, it is still not available in this country. We as a specialist for airway management should be prepared this trouble any time by equipping a laryngoscope, fiberoptic bronchoscope, and novel devices such as Airway Scope and Airtraq.